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Evidence of Binging and Purging Before the 20th Century
Although diagnostic criteria for Bulimia Nervosa did not appear until 1979, evidence suggests that binging and purging were popular in certain ancient cultures. The first documented account of bulimic behavior was recorded in Xenophon’s Anabasis around 970 B.C, in which Greek soldiers purged themselves in the mountains of Asia Minor. It is unclear whether this purging was preceded by binging. In ancient Egypt, physicians recommended purging once a month for three days in order to preserve health. This practice stemmed from the belief that human diseases were caused by food itself. In ancient Rome, elite society members would vomit in order to “make room” in their stomachs for more food at all day banquets. Emperors Claudius and Vitellius were both gluttonous and obese, and often resorted to habitual purging.

Historical records also suggest that some saints who developed anorexia (as a result of a life of asceticism) may also have displayed bulimic behaviors. Saint Mary Magdalen de Pazzi(1566-1607) and Saint Veronica (1660-1727) were both observed binge eating—giving in, as they believed, to the temptations of the devil. Saint Catherine of Siena(1347-1380) is known to have supplemented her strict abstinence from food by purging as reparation for her sins. Catherine died from starvation at age thirty-three.

While the psychological disorder “Bulimia Nervosa” is relatively new, the word “bulimia,” signifying overeating, has been present for centuries. The Babylon Talmud referenced practices of “bulimia,” yet scholars believe that this simply referred to overeating without the purging or the psychological implications Bulimia Nervosa. In fact, a search for evidence of bulimia nervosa from the 17th to late 19th century revealed that only a quarter of the overeating cases they examined actually vomited after the binges. There was no evidence of deliberate vomiting or an attempt to control weight.

Bulimia in the 20th Century
During the turn of the century, bulimia (overeating) was described as a clinical symptom, but rarely in the context of weight control. Purging, however, was seen in anorexic patients and attributed to gastric pain rather than another method of weight control.

In 1930, admissions of anorexia nervosa patients to the Mayo Clinic from 1917-1929 were compiled. Fifty-five to sixty-five percent of these patients were described as voluntarily vomiting in order to relieve weight anxiety. Records show that purging for weight control continued throughout the mid-1900s. Several more case studies reveal patients suffering from the modern description bulimia nervosa. In 1930, Venables recorded an incredibly malnourished patient vomiting. In 1939, Rahman and Richardson described that out of their six anorexic patients, one had periods of overeating and another practiced self-induced vomiting. Wulff, in 1932, treated “Patient D,” who would have periods of intense cravings for food and overeat for weeks, which often resulted in frequent vomiting. Patient D, who grew up with a tyrannical father, was repulsed by her weight and would fast for a few days, rapidly losing weight. Ellen West, a patient described by Ludwig Binswangerin 1958, was teased by friends for being fat and excessively took thyroid pills to lose weight, later using laxatives and vomiting. She reportedly consumed dozens of oranges and several pounds of tomatoes each day, yet would skip meals. After being admitted to a psychiatric facility for depression, Ellen ate ravenously yet lost weight, presumably due to self-induced vomiting. However, while these patients may have met modern criteria for bulimia nervosa, they cannot technically be diagnosed with the disorder, as it had not yet appeared in the Diagnostic and Statistical Manual of Mental Disorders at the time of their treatment.

An explanation for the increased instances of bulimic symptoms may be due to the 20th century’s new ideals of thinness. The shame of being fat emerged in the 1940s, when teasing remarks about weight became more common. The 1950s, however, truly introduced the trend of an aspiration for thinness.

In 1979, Gerald Russell first published a description of bulimia nervosa, in which he studied patients with a “morbid fear of becoming fat” who overate and purged afterwards. He specified treatment options and indicated the seriousness of the disease, which can be accompanied by depression and suicide. In 1980, bulimia nervosa first appeared in the DSM-III.

After its appearance in the DSM-III, there was a sudden rise in the documented incidences of Bulimia Nervosa. In the early 1980s, incidences of the disorder rose to about 40 in 100,000 people. This decreased to about 27 in every 100,000 people at the end of the 1980s/early 1990s. Bulimia Nervosa’s prevalence was still much higher than Anorexia Nervosa’s, which at the time occurred in about 14 people per 100,000.

In 1991, Kendler et al documented the cumulative risk for Bulimia Nervosa for those born before 1950, from 1950-1959, and after 1959. The risk for those born after 1959 is much higher than those in either of the other cohorts.